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Do you have a healing touch?

Health-care workers wash their hands only half as often as they should, according to estimates.

Carl A. Osborne

Last month, we advanced the premise that knowing when to wash your hands is an important step in reducing the risk of causing nosocomial infections, especially with resistant microbes often found in hospitals. At the end of the essay, a list of events that should prompt all personnel to wash their hands was provided.

Do you recall the events? Some are no-brainers, but others may be unfamiliar to you. Are all staff members in your hospital familiar with these events? At your next meeting, why not ask them to construct a similar list and provide the rationale for each?

This month's Diagnote focuses on how to wash your hands. In minimizing nosocomial infections, it is an evidence-based fact that how you wash your hands is equally important as when.

When you are at the hospital or clinic, are you using an acceptable protocol to wash your hands? Would you accept your hospital's hand-washing protocol if you were the patient? Have you prepared a standard operating protocol and periodically reviewed it with your staff in a timely fashion?

The main point is that to properly care for your patients, more is required than knowing the proper times to wash your hands. It is essential to know how to do so. So let me pose the question again:

How do you wash your hands?

What's the most effective procedure?

The technique chosen depends on its purpose; none is adequate for all circumstances. However, the traditional method of proper hygienic hand washing in veterinary hospitals requires three basic components (soap, running water and friction) and usually takes less than a minute. Here's how to do it:

1. Completely wet your hands and wrists in a running stream of warm water. Warm water is recommended because hot water is harsh on skin, while cold water may reduce the lathering action of cleaning agents.

Figure 1: Interlacing fingers and vigorous rubbing should be a routine part of hygienic hand-washing. Be sure to include the dorsal surface and the tips of your fingers (see Figure 2, p. 5S).

2. Apply plain soap and distribute it to the front and back of your hands and between fingers (Figure 1). Use enough soap to create lots of lather. If liquid soap is used, apply about 3 to 5 milliliters to the palm (see manufacturer's recommendation).

Figure 2: To help clean under fingernails, rub the fingertips of one hand across the palm of the other.

3. Away from running tap water, vigorously rub all surfaces of lathered hands to create friction. Be sure to inter-lace your fingers and vigorously rub them up and down. It is the abrasive action that loosens dirt and transient microbes. Because fingernail areas often harbor high numbers of microbes, pay special attention to them. One way to help clean under fingernails is to rub the fingertips of one hand across the palm of the other (Figure 2). If your fingernails are visibly soiled, clean under them with a disposable manicure stick. In addition to fingernails, areas frequently missed include thumbs and the dorsal surfaces of both fingers and hands.

4. Vigorously lather your hands for 15 seconds. The ideal duration varies, but numerous studies confirm that most people don't wash their hands long enough. The generally accepted minimum duration is 15 seconds. Washing at least that long has been found to be effective in removing most transient organisms. However, more time may be required if your hands are visibly soiled.